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The entire range of trigger-day endometrial thickness in fresh IVF cycles is independently correlated with live birth rate

  • Author Footnotes
    † Contributed equally and should be considered joint first authors.
    Monica Simeonov
    Footnotes
    † Contributed equally and should be considered joint first authors.
    Affiliations
    Infertility and IVF Unit, Helen Schneider Hospital for Women, Rabin Medical Center – Beilinson Hospital, Petach Tikva 4941492

    Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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  • Author Footnotes
    † Contributed equally and should be considered joint first authors.
    Onit Sapir
    Footnotes
    † Contributed equally and should be considered joint first authors.
    Affiliations
    Infertility and IVF Unit, Helen Schneider Hospital for Women, Rabin Medical Center – Beilinson Hospital, Petach Tikva 4941492

    Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
    Search for articles by this author
  • Yechezkel Lande
    Affiliations
    Infertility and IVF Unit, Helen Schneider Hospital for Women, Rabin Medical Center – Beilinson Hospital, Petach Tikva 4941492

    Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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  • Avi Ben-Haroush
    Affiliations
    Infertility and IVF Unit, Helen Schneider Hospital for Women, Rabin Medical Center – Beilinson Hospital, Petach Tikva 4941492

    Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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  • Galia Oron
    Affiliations
    Infertility and IVF Unit, Helen Schneider Hospital for Women, Rabin Medical Center – Beilinson Hospital, Petach Tikva 4941492

    Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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  • Ekaterina Shlush
    Affiliations
    Infertility and IVF Unit, Helen Schneider Hospital for Women, Rabin Medical Center – Beilinson Hospital, Petach Tikva 4941492

    Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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  • Eran Altman
    Affiliations
    Infertility and IVF Unit, Helen Schneider Hospital for Women, Rabin Medical Center – Beilinson Hospital, Petach Tikva 4941492

    Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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  • Avital Wertheimer
    Affiliations
    Infertility and IVF Unit, Helen Schneider Hospital for Women, Rabin Medical Center – Beilinson Hospital, Petach Tikva 4941492

    Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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  • Tzippy Shochat
    Affiliations
    Medical Statistics, Rabin Medical Center – Beilinson Hospital, Petach Tikva 4941492
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  • Yoel Shufaro
    Correspondence
    Corresponding author.
    Affiliations
    Infertility and IVF Unit, Helen Schneider Hospital for Women, Rabin Medical Center – Beilinson Hospital, Petach Tikva 4941492

    Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
    Search for articles by this author
  • Author Footnotes
    † Contributed equally and should be considered joint first authors.

      Abstract

      Research question

      What is the association of the entire range of trigger-day endometrial thickness (EMT) with live birth rate (LBR) after IVF and fresh embryo transfer? Although EMT is amenable to convenient non-invasive routine measurement, studies of the association between pre-trigger EMT and assisted reproductive technology outcome have yielded equivocal results.

      Design

      A cohort of IVF fresh day-3 embryo transfers in patients aged 42 years and younger in a single centre between 2009 and 2017. The LBR was calculated for all trigger-day EMT values, stratified into five groups overall and within subgroups of patient age and ovarian response. Univariate analysis and multivariate logistic regression models were used to compare the LBRs at different EMT measurements adjusting for various independent variables.

      Results

      A total of 5133 cycles were included. The LBRs were as follows: 11.22% (35/312) in cycles with EMT 6 mm or less, 17.98% (380/2114) in cycles with EMT 7–9 mm, 23.44% (476/2031) in cycles with EMT 10–12 mm, 25.62% (144/562) in cycles with EMT 13–15 mm and 34.21% (39/114) in cycles with EMT 16 mm or more (P < 0.001). Similar findings were observed by patient age and ovarian response. The observation was confirmed by multivariate logistic regression analysis in which the EMT was found to be a significant independent predictor of LBR even after controlling for various confounders (OR 0.935, 95% CI 0.908 to 0.962; P < 0.001).

      Conclusions

      Pre-trigger EMT is in significant independent correlation with LBR, even after adjusting for age and ovarian response. Maximal endometrial proliferation is beneficial, and fresh embryo transfer can be carried out at high EMT values without endangering the outcome of the cycle.

      KEYWORDS

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      Biography

      Yoel Shufaro MD, PhD, is the head of the Beilinson Infertility and IVF unit, and Senior Lecturer at the Felsenstein Medical Research Center, Faculty of Medicine, Tel-Aviv University. His clinical research focuses on optimizing ART and its feto–maternal outcome. His current basic research is focused on the field of fertility preservation and restoration.
      Key message
      In fresh embryo transfer cycles, a linear correlation exists between the entire range of pre-trigger endometrial thickness measurements and live birth rate. The thicker the endometrium, the higher the live birth rate, even after correction for age and ovarian response.